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[Endocopic fetal surgery].
[congenital diaphragmatic hernia]
At
present
,
the
fetus
is
already
considered
a
"
patient
"
and
as
such
,
can
develop
diseases
with
fatal
outcome
in
which
the
only
therapeutic
option
can
be
fetal
surgery
.
Currently
,
fetal
surgery
is
limited
almost
exclusively
to
endoscopic
surgery
.
Different
techniques
have
gained
clinical
acceptance
for
improving
the
prognosis
of
various
lethal
fetal
pathologies
.
Laser
therapy
for
twin
to
twin
transfusion
syndrome
and
cord
occlusion
in
monochorionic
twins
with
selective
intrauterine
growth
restriction
are
the
procedures
of
choice
for
the
management
of
monochorionic
twins
complications
,
and
are
associated
with
survival
rates
of
up
to
80
-
90
%
for
at
least
one
fetus
.
In
fetuses
with
isolated
congenital
diaphragmatic
hernia
and
severe
pulmonary
hypoplasia
,
fetal
endoscopic
tracheal
occlusion
has
shown
to
improve
the
survival
probabilities
from
5
%
to
55
%
and
from
1
%
to
33
%
in
left
and
right
congenital
diaphragmatic
hernia
,
respectively
,
and
a
decrease
in
the
rate
of
pulmonary
hypertension
and
neonatal
morbidity
.
In
selected
cases
with
low
urinary
tract
obstruction
(
megacystis
)
and
without
renal
failure
;
fetal
cystoscopy
is
a
diagnostic
method
that
excludes
the
possibility
of
urethral
stenosis
or
atresia
and
may
be
used
to
ablate
posterior
urethral
valves
by
laser
,
restoring
urethral
patency
and
potentially
preserving
respiratory
and
bladder
function
.
In
fetuses
with
pulmonary
masses
,
either
primary
or
due
to
airway
obstruction
,
there
is
high
risk
of
fetal
death
due
to
cardiac
compression
and
contralateral
pulmonary
hypoplasia
.
In
such
cases
fetal
bronchoscopy
can
provide
a
successful
therapeutic
option
to
release
airway
obstruction
.
Diseases
Validation
Diseases presenting
"either primary or due to airway obstruction"
symptom
congenital diaphragmatic hernia
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